Original article
Vocal cord dysfunction: The importance of psychologic factors and provocation challenge testing

https://doi.org/10.1016/0091-6749(87)90203-XGet rights and content

Abstract

We present three case reports involving patients with vocal cord dysfunction. The onset of symptoms in one case was coincident with a generalized cutaneous reaction to penicillin with laryngeal involvement. The other cases had been misdiagnosed as food allergy and chemical sensitivity. We describe the psychologic factors in these cases in terms of the primary and secondary gain operative in the somatoform disorder of conversion reaction and emphasize the importance of belief and learned sensitivity in the induction of symptoms. The necessity of considering psychologic factors and the use of blinded, controlled, provocation challenges to evaluate subjective symptomatology is underscored. This study emphasizes the heterogenicity of clinical presentations involving vocal cord dysfunction and illustrates the value of fiberoptic-assisted examination of laryngeal function in conjunction with provocation challenge testing in establishing causal relationships for specific clinical symptoms.

References (33)

  • AB DuBois et al.

    A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease

    J Clin Invest

    (1956)
  • RM Cherniack

    Pulmonary function testing

    (1971)
  • JC Selner et al.

    Rhinolaryngoscopy in the allergy office

    Ann Allergy

    (1985)
  • LR Derogatis
  • A Lazarus

    Multimodal life history questionnaire

    (1980)
  • DB Lindsley

    Emotion

  • Cited by (104)

    • Inductible laryngeal obstruction

      2023, Revue Francaise d'Allergologie
    • Examining the Influence of Chemosensation on Laryngeal Health and Disorders

      2023, Journal of Voice
      Citation Excerpt :

      Similarly, some authors labeled the exact chemical irritant such as glutaraldehyde,50 while other authors relied on vague descriptions such as bleaching agents.52 Of note, a patient reported that the odor of a particular food (ie, corn) provoked her symptoms.61 This finding is consistent with previous reports that specific tastants and food ingestion led to symptoms in 22%-31% of patients with irritable larynx syndrome.17,22

    • Working Towards a Common Transatlantic Approach for Evaluation of Exercise-Induced Laryngeal Obstruction

      2018, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      At an individual patient level, there is value in distinguishing EILO from asthma or other conditions to minimize unnecessary therapies, something commonly noted by investigators and also by the general press.10–12 There is also value in distinguishing EILO patients from patients with other forms of inducible laryngeal obstruction (ILO) because there is important literature devoted to psychopathology in patients with resting symptoms, sometimes stigmatizing the diagnosis.13–15 At the level of the medical provider community, streamlined recommendations are important because there is variability in terms of awareness of EILO across provider populations.

    • Vocal Cord Dysfunction Related to Water-Damaged Buildings

      2013, Journal of Allergy and Clinical Immunology: In Practice
    • Diagnostic criteria for the classification of vocal cord dysfunction

      2010, Chest
      Citation Excerpt :

      Injury or inflammation of upper airway tissue has not been demonstrated. Selner et al54 noted the importance of provocation challenges in three patients and used sensory triggers to elicit and treat VCD symptoms. A more thorough discussion of speculated potential mechanisms for exposure-associated triggers of VCD is provided in several reviews.19,35,55,56

    • Exercise-induced respiratory symptoms: an epidemic among adolescents

      2010, Annals of Allergy, Asthma and Immunology
    View all citing articles on Scopus
    View full text